Impacts of hemoperfusion combined with continuous renal replacement therapy on renal function and immune function in patients with acute renal failure caused by poisoning.

AIM: To assess the clinical efficacy of hemoperfusion (HP) plus continuous renal replacement therapy (CRRT) in patients with poisoning-induced acute renal failure (ARF), with particular focus on renal function recovery and immune function modulation.

METHODS

One hundred and sixteen patients with poisoning-induced ARF admitted to our hospital from March 2022 to March 2025 were enrolled and randomly divided into the single group receiving CRRT alone and the study group receiving HP + CRRT. The primary outcome was the reduction in serum creatinine (Scr) at 72 h post-treatment. Secondary outcomes included blood urea nitrogen (BUN), 24-h urine output, time to CRRT independence, proportion of patients achieving complete renal recovery at 28 days, immune function parameters, inflammatory markers, disease severity scores, clinical outcomes, and adverse events.

RESULTS

The combination group presented better renal function recovery, with lower serum creatinine and blood urea nitrogen levels at 48 h, 72 h, and 7 days post-treatment, and higher 24-h urine output at all time points (p < 0.05). Time to CRRT independence was significantly shorter in the combination group (p < 0.001), and the percentage of patients achieving complete renal recovery at 28 days was significantly higher (82.8% vs. 62.1%, p = 0.014). At 7 days post-treatment, the combination group demonstrated significantly improved immune function, with higher CD3+, CD4+, CD4+/CD8+ ratio, and immunoglobulin levels (IgG, IgA, IgM) (p < 0.05 for all), and lower CD8+ (p < 0.05). Inflammatory markers (CRP, PCT, IL-6) were significantly lower in the combination group at 48 and 72 h (p < 0.05). The combination group also had lower APACHE II and SOFA scores at 7 days (p < 0.001), shorter ICU stay (p < 0.001), shorter hospital stay (p < 0.001), lower 28-day mortality (10.3% vs. 24.1%, p = 0.048), and fewer adverse events (17.2% vs. 32.8%, p = 0.016).

CONCLUSION

HP combined with CRRT significantly improves renal function recovery and enhances immune function in patients with poisoning-induced ARF compared to CRRT alone, potentially by removing circulating toxins and inflammatory mediators while modulating the systemic inflammatory response.